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Wednesday, March 13, 2013

77 Poor-Quality Antidepressant Studies

Everyone who tries to become better informed about the science behind psychiatric medications sooner or later has to deal with a rather large and frustrating problem, which is that the published scientific literature on commercial drugs is spotty in quality and of dubious reliability. I've mentioned before the excellent 2005 paper on PLoS called "Why Most Published Research Findings Are False," by Dr. John P. A. Ioannidis. Interested readers will also want to consult a 2010 Atlantic article called "Lies, Damned Lies, and Medical Science," and this recent (and extensive) British analysis of bias in the scientific literature. These works mostly deal with publication bias (selective publication of studies and results), but the problems with medical research go much deeper than that. Some of the problems have to do with things like study design, but there are also deep ethical issues around ghostwriting and guest authorship, undisclosed conflicts of interest, and other issues that generally aren't issues in other realms of science, such as (say) theoretical physics.

I decided to reproduce the list here as a kind of note-to-self that I can refer back to later, when I'm reading some of the papers, but also as a reminder to myself and others that the literature surrounding many of the latest drugs for the treatment of depression is basically not to be taken at face value. All scientific literature (in all fields) needs to be viewed critically. That's not the issue. The issue is that the scientific literature surrounding psychiatric drugs is particularly treacherous.

Which drugs do the 77 papers talk about? They all refer to one or more of the medications shown in this table:

Generic
Name

U.S. Trade Name

Bupropion

Wellbutrin®;
Wellbutrin SR®;
Wellbutrin XL®

Citalopram

Celexa®

Desvenlafaxine

Pristiq®

Duloxetine

Cymbalta®

Escitalopram

Lexapro®

Fluoxetine

Prozac®;
Prozac Weekly®

Fluvoxamine

Luvox®

Mirtazapine

Remeron®
Remeron Sol tab®

Nefazodone

Serzone®

Paroxetine

Paxil®;
Paxil CR®

Sertraline

Zoloft®

Trazodone

Desyrel®

Venlafaxine

Effexor®;
Effexor XR®

These drugs represent some of the most popular medications in America today. All of these drugs are approved for use in treatment of depression except for Luvox, which is widely prescribed off-label for depression. (The only approved use of Luvox is for OCD.)